Book an Appointment / Get Expert Advice
416-481-8880
 

The New Updated Concussion Guidelines

April 8th, 2013

The New Updated Concussion Guidelines

As athletes, sports we play have a significant probability of incurring trauma to the head. Concussion has become a household term, but do we truly understand what a concussion is? No…well don’t worry you are not alone. In fact even the leading minds in concussions and concussion associated symptoms have to meet every four years to collaborate and create a consensus on: what constitutes a concussion, how do we evaluate someone for a concussion, what do we need to know to return that player to sport safely, and more. The purpose of this article is to review the current definition of concussion, the common symptoms and signs and the return to play guidelines as set forth by the most recent collaborative conference on Concussion.

Concussion Defined

“Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces”

a) It may be caused by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head
b) It usually results in short-lived impairments of neurological function
c) The acute clinical symptoms largely reflect a functional disturbance (i.e. no evidence is seen on structural neuroimaging)
d) Concussion results in a graded set of clinical symptoms that may or may not result in a loss of consciousness.

Return Safely to Play

85 – 90% of concussions resolve in 7-10 days. During this time, the currently agreed upon consensus would have us do the following steps in order for us to safely return to play”
1) Initial rest period (no activity) of 24-48 hours. The purpose is for recovery.
2) Light aerobic exercise like walking or light swimming. The purpose here is to see how the symptoms respond to an increased heart rate (try not to exceed 70% maximum heart rate at this stage)
3) Sport-Specific exercise like light skating or soccer drills for example. The purpose of this stage is to add more movement with the increased heart rate.
4) Non-contact training drills. At this point the player should be practicing in all drills and can start resistance training. The purpose is to see how exercise, coordination and cognitive load affect the symptoms.
5) Full contact practice should always be done before going back into a game situation. It helps to restore confidence and allows assessment of the players functional skills
6) Finally return to play

How to Manage the Steps

The above steps are to be progressed in a day-by-day manner, where step by step progression occurs only after a full day without concussion like symptom exacerbation. Therefore if you attempt some non-contact training drills and the symptoms come back, than you revert back to sport-specific exercise the next day. It is also important to mention that if you are taking any medications for these symptoms, that return to play should not be allowed until you are able to do full contact practice without the aids of medication.

In the smaller amount of cases of concussions that linger past 10 days (roughly 10-15%), after attempting the above steps, it is advised that the person manages the concussion in a multidisciplinary manner. This is where we at the Urban Athlete can help, providing a proper assessment of the neck as many concussion-like symptoms can be reduced with proper treatment.

Conclusion

This is a very brief overview of concussion but for further information click the link below to read the actual article “Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012”.
http://bjsm.bmj.com/content/47/5/250.full.pdf+html
We want our athletes to participate in a wide range of sports, and sometimes the most aggressive ones are the most fun to play and watch, but we urge you to play safe.

Dr. Shaun, The Urban Athlete
drbatte@theurbanathlete.ca

Thoracic Mobilization With Dr. Shaun Batte (Part 2)

May 8th, 2012

Dr. Shaun Batte takes you through some great exercises for limbering up your mid section.

Wow, The Nike Free Running Shoe Might Do What They Claim

October 4th, 2011

Purpose: quick review of a research abstract of a paper investigating the influence of running in the Nike Free on foot muscle strength and size.

By Greg Lehman

Check out Greg’s full posting here:    The Body Mechanic

A research abstract (not a full paper) was published at the American Society for Biomechanics conference in 2010 by Dr. GP Brunnemann and colleagues.

“Effect of increased mechanical stimuli on foot muscles functional capacity”

The Study Overview

The authors had two groups of athletes.  One group ran in the Nike Free during their warm up sessions over the course of five months while the other group did not (they wore their  usual trainers).  Too bad the “control” group did not go barefoot or wear flats.  That would have been interesting as well.

The authors measured foot strength during plantar flexion, toe flexion, supination strength (e.g. the ability to resist pronation) and also measured the size of some of the muscles that influence the foot (plantar flexors, tibialis anterior, flexor hallucis longus, flexor digitorum longus, tibialis posterior and peroneals).

What they found

Strength changes…

An increase in strength of plantar flexion, supination, flexion of the metatarsal phalangeal joints (toes) ONLY  FOR THE GROUP WHO WORE THE NIKE FREEs.

Muscle changes…

Not all muscles got bigger.  Only the flexor hallucis longus (the muscle going to the big toe) and the flexor digitorum longus (the muscle going to all of the toes) got bigger.  They got bigger by about 4%.  Additionally, two other tiny muscles in the sole of the foot (the quadratus plantae and abductor hallucis) enlarged by 5%.
What muscles did not change in size?

tibialis anterior, plantar flexors (gastroc and soleus), tibialis posterior, peroneals, abductor digiti minimi, flexor digitorum brevis

Interesting findings…what does it mean?

Nike suggests that these results support the idea that these shoes mimic running in barefoot (www.wiggle.co.uk/documents/Nike_Brochure_V4.pdf).

However, I don’t think we can conclude that, since this was not measured (the researchers don’t conclude this).  For all we know, running in these shoes may stress the muscles completely differently than running barefoot and barefoot running may result in more robust results. Remember, not all muscles got bigger and not all movements got stronger.  Regardless, this study supports the idea that the Free can be used as a training adaptation shoe.  Strength increases were seen, as were size increases in small muscles of the foot.  This occurred with a very small amount of training (merely warming up).  In practice, we may want to suggest that our athletes do their cross training and strength training in this type of minimalist shoe (or have them go straight to barefoot).  Or do what I do and wear them to work (I wear the now defunct LunarRacer).

My philosophy is that every athlete (and everyone is an athlete) should train all aspects of their body.  The body responds to stress so we must find novel ways to stress our system.  Provided that shoes like these are introduced slowly and follow a paced progression then incorporating this type of training into your usual day may provide some benefit.

Welcome Back

September 8th, 2011

We are excited to welcome back Jen Hunter from maternity leave.  Jen will be in the office Tuesday and Thursday mornings.  Please call to book an appointment.
 
We are also please to welcome back Osteopathic Practitioner Luke Fuller from his stint on the Professional Men’s tennis tour.

Tee off with these positioning tips from golf expert Dr. Gavin Maxwell

September 5th, 2011

Golf expert Dr. Gavin talks about strength exercises to help you tee off. Try the three exercises to strengthen the pelvic and hip stabilizers and see your game improve, especially over the last 4 or 5 holes.

1. ‘Glute’ Bridge – 20 repetitions

Step 1- Lie on your back, knees bent, your feet flat on the floor, hip width apart.
Step 2- Raise hips off the floor to form a straight line from your knees to your chest. Hold for 5 seconds and slowly lower your hips down. Avoid the knees going inward.
Advanced- From the raised position, straighten one leg up and hold. Avoid letting your hip drop down while you raise your leg. Alternate each leg for 15 repetitions.

2. Resisted Side Step- 20 repetitions

(For this movement, an elastic ring band or therapy band tied into a ring is required.)
Step 1- Place the elastic ring around your ankles and stand with your feet together.
Step 2- Slide your leg out to the side so there is resistance on the band. Bring the other leg towards the starting leg so your feet are almost together. Continue in one direction for 10 repetitions, and then back in the other direction. Keep your body upright and your feet facing forward.

3. Lateral Hip Raises- 10 repetitions per side

Step 1- Lie on your left side on the floor. Cross your upper (right) leg in front of your lower leg.
Step 2- Support your upper body with your left arm, palm and hips on the floor, and upper body at an angle.
Step 3-Place right hand on your hip.
Step 4- Without bending at the waist, raise your hips upward supporting yourself with your arm and feet.
Step 5- Slowly lower your hips to the floor.
Step 6- Repeat 10 times and then repeat on the other side.

Checklist for Healthy Living

August 5th, 2011

Being at the cottage this summer, surrounded by quiet beauty, I am reminded about how few things we need to be healthy and happy. I am away from the hustle and bustle, schedules and deadlines, and the “stuff” I deem so necessary to get through my days, and I see how living simply means living healthy.

Here are the top 5 areas to focus on to live a simple and healthy life:

1. Water- Drink enough water to avoid thirst. This usually translates into 8-10 cups per day. Drink most of your water away from meals so as not to dilute the gastric juices when digestion is necessary. Being IN water is also very healing and cleansing for the body. Swim in a lake, the ocean, or in a pool as often as you can.

2. Whole food- Eat cleanly. Eat as many foods as possible that contain only one ingredient (eg. apple, brown rice). If you are eating prepared foods, eat only foods with short lists of ingredients you can understand. Only eat until you are satisfied-never full. Eat every 3-4 hours.

3. Movement- Exercise daily. This does not mean you must go to the gym everyday if you do not enjoy it. This means taking the stairs instead of the elevator; walking or biking to the store instead of driving; gardening; playing tag with your kids. Perform activities that put a smile on your face.

4. Quiet Reflection- Commit 5-10 minutes every day you can to sitting back and simply thinking. Asking yourself the following questions may help: “Am I happy?” “How do I feel today?” “Am I taking good care of myself?” Taking the time to reflect will help you live a more meaningful and present life.

5. Love and Connection- Surround yourself with the ones you love and cultivate deeper relationships with them. When is the last time you asked a loved one how they really are? Being emotionally close and open with those around us does so much good for the soul.

Focus on these things as much as possible and you will be on your way to living a beautifully simple and healthy life.

Optimal Running Form For Injury Prevention

July 14th, 2011

By Dr. Erica Ainsworth

Do you want to run faster with less effort?   Do you want to run injury-free?  The following techniques will get you running more efficiently from head to toe.

HEAD
• Your torso will always follow what your head is doing – so keep your head up and don’t allow your chin to jut forward.
• Look ahead naturally several feet ahead of foot strike, not down at your feet.

SHOULDERS
▪ Keep them low and loose, not shrugged up high and tight. As you get fatigued late into a run, avoid letting your shoulders creep up toward your ears.
▪ Shoulders should stay square – facing forward.

TORSO AND BACK
▪ Use a slight forward lean (but not at the waist) and “run tall” to promote optimal lung capacity.
▪ Leaning too far forward leads to injuries to the hamstrings, groin, calves, neck, and back while leaning too far backward can lead to back pain.

ARMS
▪ Arms should swing naturally and loosely at about 90 degrees.
▪ Keep your hands gently cupped, not clenched.
▪ Hands should never cross the midline of your chest.
▪ Arms too high can lead to neck, shoulder and upper back stiffness.

HIPS AND KNEES
▪ Hips, knees and feet should be in line.
▪ Keep the hips forward in line with the rest of your body, not shifted back.

FOOTSTRIKE
▪ Your foot should hit the ground UNDER your center of gravity (rather than ahead of the body).
▪ Land on your mid-foot or forefoot with your knee slightly bent to absorb shock.
▪ Excessive toe strike increases strain on lower leg and overworks the calves.
▪ Excessive heel strike increases injuries in the knees, hips and back.

 

 
505 Eglinton Ave. West Suite 302 Toronto, ON M5N 1B1.
©Copyright 2009 The Urban Athlete Inc.  Created & Maintained by : WSI